Scope of Practice

SCOPE OF PRACTICE

Task Force on the Expansion of Perfusion


Purpose

This document aims to define the Scope of Practice for Clinical Perfusionist Professionals and specify their role as members of the health care team, acting in the best interest of the patient. The scope of practice is a “living” document that will evolve as techniques and technology expand.

The scope of practice defined here and the areas expressly set forth describe the breadth of professional practice offered within the profession. Levels of education, experience, skill, and proficiency for the activities identified within this scope of practice vary among providers; a Clinical Perfusionist does not typically practice in all areas of the field. As the American Society of ExtraCorporeal Technology Code of Ethics specifies, individuals may only practice in areas where they are competent based on their education, training, and experience. However, Clinical Perfusionists may expand their current level of expertise. Certain situations may necessitate that the Clinical Perfusionist pursue additional education or training to develop their scope of practice.

The scope of practice statement does not supersede existing state licensure laws or affect the interpretation or implementation of such laws. However, it may serve as a model for the development or modification of licensure laws.

Clinical Perfusion is a dynamic and continuously evolving profession; listing specific areas within the scope of practice does not exclude emerging practice areas. Although not explicitly identified in this document, in certain instances, Clinical Perfusionists may be called on to perform services (e.g., “multiskilling” in a health care setting, collaborative service delivery in schools) for the well-being of the individual(s) they are serving. In such instances, it is both ethically and legally incumbent upon professionals to determine that they have the knowledge and skills necessary to conduct such tasks.

Definition of the Profession

The Clinical Perfusionist Professional is an individual qualified by professional credentialing and academic and clinical education to provide extracorporeal patient care services. The scope of practice of the Clinical Perfusionist Professional includes those procedures, acts, and processes permitted by law. The individual has received education and clinical experience in which they have demonstrated competency.

Scope of Practice of the Profession

1.1. Extracorporeal Support

1.1.1. Cardiopulmonary bypass for Adult, Pediatric, and Neonatal Patients
1.1.2. Cardiopulmonary bypass for congenital and acquired cardiovascular disorders
1.1.3. Extracorporeal circulatory support for renal, neurological, hepatic and vascular surgery
1.1.4. Extracorporeal resuscitation
1.1.5. Extracorporeal circulation for long term support of failing respiratory and/or cardiac function

1.2. Associated Extracorporeal Support Functions

1.2.1. Myocardial protection
1.2.2. Hemofiltration/hemodialysis
1.2.3. Anticoagulation and hemostasis monitoring, analysis, and intervention
1.2.4. Thermal regulation
1.2.5. Blood gas and blood chemistry monitoring, analysis, and intervention
1.2.6. Physiological monitoring, analysis, and intervention
1.2.7. Administration of blood components, pharmaceuticals, and anesthetic agents

2.1. Heart Failure Therapy and Support

2.1.1. Ventricular Assist Device management
2.1.2. Intra-aortic Balloon Counterpulsation
2.1.3. Temporary Pacemaker management
2.1.4. External counterpulsation
2.1.5. Transportation of Extracorporeal Supported Patients
2.1.6. Hemofiltration (i.e. “Aquapheresis”)
2.1.7. Periodic flow augmentation therapy

3.1. Blood Management

3.1.1. Autotransfusion
3.1.2. Platelet Gel Production
3.1.3. Non-Differentiated Progenitor Cell Harvest
3.1.4. Acute Normovolemic Hemodilution
3.1.5. Phlebotomy
3.1.6. Hemostasis monitoring and analysis

4.1. Other Clinical

4.1.1. Isolated Limb/Organ perfusion
4.1.2. Isolated limb/organ delivery of chemotherapeutics, progenitor cells, gene therapy vectors, ect.
4.1.3. Organ Procurement
4.1.4. Thermogenic lavage
4.1.5. Organ Preservation
4.1.6. Dialysis
4.1.7. Surgical assistance
4.1.8. Electrophysiological analysis
4.1.9. Therapeutic Hyperthermia
4.1.10. Therapeutic Hypothermia
4.1.11. Intravascular membrane oxygenation

5.1. Non-Clinical Responsibilities

5.1.1. Documentation of duties via the official medical record
5.1.2. Education, including the establishment and management of educational programs for new and current clinical perfusionists, other healthcare providers, and consumers
5.1.3. Administration, including managing all aspects - technical, fiscal, workflow, and human resources - of Clinical Perfusion operations
5.1.4. Quality Control and Assurance
5.1.5. Regulatory Compliance
5.1.6. Competency/Performance Evaluation

6.1. Professional Performance

6.1.1. Obtains and maintains appropriate professional credentials
6.1.2. Works in partnership with other health care professional to provide the best medical care possible for all patients
6.1.3. Adheres to the standards, policies, and procedures adopted by the profession and regulated by law
6.1.4. Stays current with required continuing medical education (CME) in order to stay abreast of changes in the field of extracorporeal technology and to maintain professional credentials
6.1.5. Participates in continuing education activities through professional organizations, to enhance knowledge, skills and performance
6.1.6. Adheres to the accepted professional ethical standards as defined by the Code of Ethics
6.1.7. Acts as a patient advocate supporting patients rights
6.1.8. Design, coordination, and implementation of original investigation
6.1.9. Critical evaluation of published research

Appendix

Code of Ethics & Interpretive Statements